title: Executive impairment determines ADHD medication response: implications for academic achievement.
abstract: Methylphenidate (MPH) often ameliorates attention-deficit/hyperactivity disorder (ADHD) behavioral dysfunction according to indirect informant reports and rating scales. The standard of care behavioral MPH titration approach seldom includes direct neuropsychological or academic assessment data to determine treatment efficacy. Documenting "cool" executive-working memory (EWM) and "hot" self-regulation (SR) neuropsychological impairments could aid in differential diagnosis of ADHD subtypes and determining cognitive and academic MPH response. In this study, children aged 6 to 16 with ADHD inattentive type (IT; n = 19) and combined type (n = 33)/hyperactive-impulsive type (n = 4) (CT) participated in double-blind placebo-controlled MPH trials with baseline and randomized placebo, low MPH dose, and high MPH dose conditions. EWM/ SR measures and behavior ratings/classroom observations were rank ordered separately across conditions, with nonparametric randomization tests conducted to determine individual MPH response. Participants were subsequently grouped according to their level of cool EWM and hot SR circuit dysfunction. Robust cognitive and behavioral MPH response was achieved for children with significant baseline EWM/SR impairment, yet response was poor for those with adequate EWM/ SR baseline performance. Even for strong MPH responders, the best dose for neuropsychological functioning was typically lower than the best dose for behavior. Findings offer one possible explanation for why long-term academic MPH treatment gains in ADHD have not been realized. Implications for academic achievement and medication titration practices for children with behaviorally diagnosed ADHD will be discussed.
authors.affiliation: Professor, Department of Psychology, University of Victoria, Victoria, British Columbia, Canada. jbhale@uvic.ca
authors.forename: James B
authors.initials: JB
authors.lastname: Hale
authors.forename: Linda A
authors.initials: LA
authors.lastname: Reddy
authors.forename: Margaret
authors.initials: M
authors.lastname: Semrud-Clikeman
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Hain
authors.forename: James
authors.initials: J
authors.lastname: Whitaker
authors.forename: Jessica
authors.initials: J
authors.lastname: Morley
authors.forename: Kyle
authors.initials: K
authors.lastname: Lawrence
authors.forename: Alex
authors.initials: A
authors.lastname: Smith
authors.forename: Nicole
authors.initials: N
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004521:Educational Measurement; D056344:Executive Function / Q000187:drug effects; D005260:Female; D006801:Humans; D007858:Learning / Q000187:drug effects; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D009483:Neuropsychological Tests
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate